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Correspondence to Author:  Nahid Saadati, 

Department of Obstetrics and Gynecology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract:

Premature pregnancies are more likely than full-term pregnancies to result in foetal and neonatal problems. In addition to improving neonatal survival and quality of life, treating preterm labour and delayed delivery lowers the medical expenses associated with caring for premature babies. The purpose of this study was to evaluate the detrimental effects of magnesium sulphate and nifedipine on the arrest of premature labour.
One hundred pregnant patients who were admitted to the hospital due to preterm labour pain participated in this clinical trial study, which was randomised. The study included pregnant participants who were between 28 and 34 weeks along with a single pregnancy and preterm symptoms. They were split into two equal groups at random. When fluid therapy failed to reduce the discomfort, an injection of magnesium sulphate (N=50) was administered to the first group, and oral nifedipine was given to the second. The study analyses test results using descriptive statistical techniques, such as the independent T test and the chi square test, using SPSS software (version 20) statistical software issue 20.
Keywords:
Preterm Delivery, Nifedipine, Magnesium Sulfate.

Introduction:  One of the most astounding physiological events in human history, giving birth can be safe and enjoyable in most cases, but there are some cases where it can result in significant challenges and complications for both the mother and the foetus. Numerous factors can have an impact on pregnancy (Valadbeigi et al., 2017). One of these issues is preterm labour. (Moramezi, Cheraghi, Saadati, & Sokhray, 2014) An early baby’s birth difficulties can be extremely expensive to care for and treat each year, and families may suffer irreversible stress from mental and psychological strokes. Actually, the main purpose of a pregnancy is to give birth to a healthy, straightforward baby.
Given the significance of the topic and the rise in preterm birth rates in recent years, Numerous investigations and efforts have been made to diagnose, treat, and prevent premature labour. However, during the past 20 years, affluent countries have made no progress in lowering the prevalence of preterm delivery, and their gains have mostly been in the area of treatment. (Petraglia, Gabbe, Wiess, & Strauss, 2007) Preterm labour is more likely in cases of pyelonephritis, diabetes, a history of abdominal and pelvic surgeries, and genital and urinary tract infections. (Chehre, Eivazi, Borji, Karaallahi, & Safar, 2018) The antenatal care practise informs all pregnant women on the signs of early labour. If women experience regular, painful contractions, they must visit the hospital. If uterine contractions do not occur, they should be self-monitored. for review. Although it cannot be prevented, preterm delivery can be put off for a few days. This delay can have a significant effect on the results of preterm labour, such as the premature infant’s mortality and morbidity (in terms of their physical, mental, and evolutionary needs, as well as the financial load and consequences that occasionally last a lifetime).
The actions of prostaglandins result in uterine contractions. As a class of paracrine hormones, prostaglandins function where they are produced. A crucial parturition event that is followed by the start of the uterine contraction may be the decidua and foetal membranes producing prostaglandin. Preterm uterine contractions appear to be prevented by either suppressing prostaglandin production or preventing their effects.

Method:   100 pregnant patients with a gestational age of 28 to 34 weeks who have been admitted to Ahwaz’s Imam Khomeini Hospital since 2017 due to a diagnosis of preterm labour are the subjects of this phase 2 randomised clinical research. The procedure was carried out with consent and in compliance with the exclusion (anyone who cannot continue their pregnancy due to contraindications or issues administering magnesium sulphate or if they experience at least three contractions lasting 30 seconds for 20 minutes along with increased dilatation and cervical effacement) and inclusion criteria.
Prior to administering a 500cc Ringer with a quick infusion, all patients in this trial have their vital signs examined. If the uterine contractions persist, The patient was randomised to receive either group B—magnesium sulphate (n = 50) or group A—nifedipine (n = 50). Next, magnesium sulphate is injected intravenously at a rate of 4 mg, then 2g/h for 24 hours, and nifedipine is first given orally at a dose of 20 mg every 6 hours for 24 hours.
The magnesium sulphate recipient group received an oral placebo in addition to an injectable medication in this study for blinding purposes, while the nifedipine group received ringer serum in addition to the oral medication. As a result, the patient, the treating physician, and the treatment team of the study participants are unaware of the process used to assign patients to groups. After that, a comparison is done between the onset of pain relief therapy and the development of premature labour. Vital signs, vaginal haemorrhage, foetal membrane rupture, heart rate, uterine contractions, and mother blood pressure are all recorded during the study.
The questionnaire will include midwifery details regarding the expectant mother, her exams, the kind of prescribed medication, adverse effects, treatment failure cases, and the time between starting treatment and experiencing relief from discomfort or stillbirth. Information is not included in cases where foetal distress or other factors led to the induction of labour. Factors include the number of deliveries, the gestational age of the mother, the history of preterm labour, the rate of cervical dilation and effacement, Measured and examined were the intensity of uterine contractions, the time interval from the start of preterm labour to the start of treatment, and the time interval from the start of treatment to the improvement of discomfort or delivery. The frequency and percentage of the qualitative variables and the mean and standard deviation of the quantitative variables are used to characterise the data. The t-test (Mann-Whitney if needed), chi-square test, logistic regression, and survival analysis method were utilised for data analysis.

Results:   There was no statistically significant difference in the number of uterine contractions, cervical effacement and dilatation at the beginning of treatment, maternal age, gestational age, or number of previous deliveries among the 100 pregnant women with gestational ages of 28 to 34 weeks who were randomly assigned to the Nifedipine and Magnesium sulphate groups.

Discussion:   Preterm labour must be prevented and treated in order to lower the risk of unfavourable complications for newborns, improve survival rates, and improve their quality of life. Preterm birth management really aims to improve infant outcomes and lower morbidity and mortality rates in addition to extending pregnancy.
Because of this, we ought to make every effort to avoid premature labour by removing the contributing factor or inhibiting uterine contractions. The purpose of this study was to compare the effectiveness of magnesium sulphate and nifedipine in preventing preterm labour. The results indicated that there was a statistically significant difference between the two groups’ responses to treatment, with the nifedipine group responding to treatment more favourably. Not a single patient in either of the two groups experienced a problem that required stopping their medication. The effectiveness of the two medications in postponing birth for 48 hours was comparable in a 2007 Lille research, and the group that received nifedipine experienced fewer maternal problems. Consistent with the findings of this study, Dr. Faraji’s 2013 study conducted in Iran discovered that if labour was postponed for more than 48 hours, nifedipine was more successful than magnesium sulphate.
In a 2007 Stanford University study, Deirdre discovered that magnesium sulphate was more effective than nifedipine at halting contractions within the first 48 hours (87% versus to 72% at p = 0.01), Nifedipine was significantly associated with fewer maternal complications, but delayed labour, gestational age at delivery, and neonatal major outcomes were similar in the two groups (Deirdre, Pullen, Campbell, Ching, Druzin, Chitkara, Burrs, Caughey, & EL-Sayed, n. d.). These results contrast with our recent study.
Similar to our study’s findings, a 1999 investigation by Dr. Haghighi at the University of Tehran found that while both nifedipine and magnesium sulphate had comparable efficacy and side effects, nifedipine had a quicker effect on halting uterine contractions (Haghighi, 1981). In a different Glock study from 2002, oral nifedipine was just as successful as magnesium sulphate in comparing the effects of the drug on patients with premature labour.

Citation:

Nahid Saadati. Sulphate of magnesium and Nifedipine: A Comparative Analysis for Reducing Premature Delivery. The Journal of Molecular Biology 2024.